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| lacare.org | 1.855.270.2327 | TTY 711

A Newsletter for L.A. Care Covered™ Direct Members

Live a Longer, Healthier LifeDid you know that regular physical activity increases your chances of living a longer, healthier life? It can also help improve your mental health and reduce your risk for high blood pressure, heart disease and some types of cancer. Physical activity is for everyone. No matter what shape you are in, you can find activities that work for you.

Here are some tips to help you get started:

• Reduce sedentary time and increase active time. For example, you can take a walk after dinner instead of watching TV.

• Schedule specific times for physical activity. Make it part of your daily or weekly routine.

• Do things that you enjoy. Some people might like running in their neighborhood in the mornings; others might prefer an exercise class at a health club after work.

• Enlist your friends or family members to help you with motivation and support.

• Start slowly and work your way up to more physically challenging activities. For many people, walking is a good activity to start with.

Keep in mind that the L.A. Care Family Resource Centers offer free health education and exercise classes. You can sign up for Aerobics, Dance,

Tai Chi, Yoga, Zumba® classes and much more. The centers are in Pacoima, Inglewood, Boyle Heights, Lynwood, Palmdale and East L.A. For more information or to enroll in classes, call 1.877.287.6290 (TTY 711) or visit lacare.org/frc. Consult with your doctor before starting any exercise program.

Together, we can get more active now and throughout the year!Sources: cdc.gov; healthfinder.gov

This year L.A. Care Covered™ Direct is celebrating the 25th anniversary of National Infant Immunization Week, April 27-May 4. Since 1994, communities across the United States have joined together to celebrate the critical role vaccinations play in protecting our children, communities, and public health. Immunizations are one of the best ways parents can protect infants, children and teens. We encourage you to vaccinate your child.

Immunizations (vaccines) help keep your baby or child from getting sick. Most immunizations are given as shots, but some, such as rotavirus, are given by mouth. They work by helping the body fight illness.

It is important for your child to get shots at the right time. That’s why your child needs to see a doctor for well-care visits. Follow the schedule your doctor gives you. Bring your immunization record (yellow card) with you.

Keep Your Child Happy

My Health In Motion™ Personalized Online Wellness

Did you know you have personalized wellness information at your fingertips? With just a few clicks or swipes, you can access a wide range of online health activities and tools. Whether you want to quit smoking, lose weight, or manage stress, L.A. Care’s My Health In Motion™ site has something for you! You can even earn gift card rewards to some of your favorite stores by completing a lifestyle survey, participating in workshops and speaking with our certified health coaches!

It allows you to go at your own pace with ease from your computer or phone. There is no need to make an appointment, no traveling, or wait time. Log on any time, day or night, whatever fits your schedule. Sign in at lacare.org under “Member Sign in” and click on the “My Health In Motion™” tab to see all the fun tools that can help you stay healthy. You’ll find:

• A lifestyle survey with a personal health report that offers real-world tips to improve your health

• Interactive guides on exercising, healthy eating, quitting smoking, and managing your weight

• Health trackers to help you reach your health goals

• Interactive online health workshops

• A health information library

• Healthy recipes and meal plans

With My Health In Motion™ you can even send a message to a health coach, trainer or dietitian. Get your personal health questions answered by a qualified health professional!

If you have questions or need help with My Health In Motion™ call L.A. Care’s Health Education Department at 1.855.856.6943 (TTY 711).

Your family’s health is our priority. Immunizations and well-child visits are covered by L.A. Care Covered™ Direct at no additional cost. If you have questions or need more information, call us at 1.855.270.2327 (TTY 711).Source: cdc.gov

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Preventive care is free for L.A. Care Covered™ Direct members. Start the new year off right by scheduling an appointment for your annual checkup with your primary care physician (PCP). It is one of the simplest and most important steps you can take to stay healthy. Ask your PCP what preventive screenings and care you need. L.A. Care Covered™ Direct members can receive these services at no charge:*

*Preventive care is not subject to co-pays or deductibles. However, co-pays and deductibles may apply if you receive non-preventive care during your visit. Non-preventive care includes treatment for medical conditions.

Service Who needs the serviceAnnual physical or checkup Everyone

Immunizations Ask your PCP

Pap and HPV tests Women ages 21-65

Mammograms Women ages 50-75

Colorectal cancer screening Men & women ages 50-75

Chlamydia screening Women ages 16-24

Spring Is Here!Celebrate the season with these healthy behaviors.

• Get at least 150 minutes of physical activity every week (30 minutes a day, 5 days a week).

• Eat a healthy diet with more fruits and veggies and less salt, saturated fat, and added sugar.

• Quit smoking. You can quit today! Call the CA Smokers’ Helpline at 1.800.NO BUTTS (1.800.662.8887) for free support.

• Get at least 7 hours of sleep every night.

• Stay up-to-date on your health screenings.

• Wear sunscreen and insect repellent.

Source: cdc.gov

Get a Checkup. It’s Free!

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Sweeten Your Life

Do You Need to See a Doctor?Getting in to see your doctor doesn’t have to be hard. L.A. Care adheres to rules about how long you should wait to get a doctor appointment.

You should be able to get an appointment within these timeframes:

Primary Care Doctors• Routine appointment (non-urgent:)

10 business days

• Urgent appointment (no authorization required): 48 hours

Specialists• Routine appointment (non-urgent):

15 business days

• Urgent appointment (requiring prior authorization): 96 hours

Did you know you can get health advice when your doctor’s office is closed and on weekends or holidays?

• L.A. Care doctors must be available, or have someone available, to help you at all times.

• If you need to talk to your doctor when the office is closed, call your doctor’s office phone number. Follow their instructions.

• A doctor or nurse should call you back within 30 minutes.

If you have trouble reaching your doctor, call L.A. Care’s Nurse Advice Line at 1.800.249.3619 (TTY 711) 24 hours a day/7 days a week. A nurse will give you the health information you need. Remember, if you have a medical emergency and need help right away, dial 911 or go to your nearest emergency room.

* The applicable waiting time for a particular appointment may be extended if the referring or treating health care provider has determined and noted in the patient record that a longer waiting time will not have a detrimental effect on the health of the member.

Spring brings the sweetness of beautiful, warm days, tasty fruits and lovely flowers as the birds and bees get busy doing their work in nature. The season can also be a reminder to sweeten your life in a healthy way by choosing the right amount and type of sweets that you eat.

Foods sweetened with sugar may taste good, but the calories and your blood sugar levels can add up fast. When using natural sweeteners such as sugar, honey, agave nectar or stevia, less is better. Artificial sweeteners such as aspartame (Equal, NutraSweet), saccharin (Sweet’N Low) or sucralose (Splenda) can help you lower the sugar in your blood but be careful of the health risks they may cause. Know which sweeteners are safe and do not have negative effects.

Make healthier choices, such as fruits, veggies and whole grains. Check the nutrition label on your food and drinks. Make water your go-to drink. Sodas, juices and other energy drinks are loaded with sugar. Every 4 grams of sugar is equal to 1 teaspoon of sugar. A 12-ounce can of a regular soft drink has an average of 39 grams of sugar or a little over 9 teaspoons of sugar! Having a sweet treat such as candy or pastry occasionally is okay, if you balance it by keeping the portions small and make healthier choices daily.

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Protect YourselfIf someone gets your medical ID or Social Security number, you could become a victim of medical identity theft. Once they have it, they can use it to see the doctor, buy prescription drugs, or submit fake bills in your name. Medical identity theft can also damage your credit rating and harm your health. If false information gets into your medical records, you may get the wrong treatment. Here are some ways to protect yourself against medical identity theft:

If you have questions about your bill and/or Explanation of Benefits or think there is a mistake, please call Member Services at 1.855.270.2327 (TTY 711).

9 Do not trust strangers who offer free or discounted medical services. 9 File paperwork and shred what you do not need. 9 Keep your insurance and Social Security numbers safe. 9 Never share your information with persons who say they are bill collectors. If they really are bill collectors, they will already have your information.

9 Review your medical bills and statements (if any) and/or your Explanation of Benefits. Check for items or services you did not receive. If you see something strange or wrong, call your health care provider.

Take Care of Your Mental HealthMay is Mental Health Month. L.A. Care Covered™ Direct encourages members to make their mental health a priority. Mental health refers to how you feel, think and act. It consists of the way you feel about yourself and your ability to manage your emotions and handle difficulties.

For good mental health throughout your life, try these steps:See a professional.If you have depression or anxiety, talk to a mental health professional about treatment.

Stay physically active.Physical activity boosts your mood and may be as effective as medicine in reducing symptoms of depression.

Watch what you eat and drink.Eat plenty of fresh fruits and veggies. Avoid caffeine, alcohol and foods high in sodium (salt).

Do not smoke.Smoking tobacco is linked to depression. If you do smoke, learn how to quit.

Get support from loved ones.Talk to trusted family or friends about what you are feeling.

Coverage for mental or behavioral health care and substance use treatment is included in the benefits for L.A. Care Covered™ Direct members. If you or a loved one needs these services, please visit your primary care provider (PCP) or contact Beacon Health Options at 1.877.344.2858 (TTY 1.800.735.2929), 24 hours a day, 7 days a week, including holidays. In case of an emergency, please call 911.

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The L.A. Care Formulary Has You CoveredL.A. Care Health Plan has a Formulary that is an approved list of covered drugs for its members. It is reviewed and updated monthly for safety and effectiveness. The Formulary and updates are available online at lacare.org.

How to Use the Formulary • Formulary drugs are listed by their generic and brand

name as follows: Generic name (BRAND NAME)

• If only the brand name drug is on the market, only that will show: BRAND NAME

• Drugs can be searched on the online Formulary by generic or brand name, or therapeutic category. Using the “Ctrl + F” function or the index makes it easy.

Generic and Brand Name Medications • Generic and brand name drugs are covered.

• Generic drugs are safe and cost-effective.

• Brand drugs are used when a generic drug is not available.

Non-Formulary Medications Drugs not listed on the Formulary are not covered (non-formulary).

Benefit Coverage and Limitations Quantity Limits (QL): Some drugs have quantity limits for safety or cost reasons.

Step Therapy (ST): Requires trying one or more drugs first (Step Process).

Medication Request Process The Medication Request Process requires a Prior Authorization (PA) request from your doctor.

The following drugs need a PA:

• Non-formulary drugs

• Formulary drugs needing safety or cost reviews.

• Formulary drugs that exceed quantity limits (QL).

• Step therapy (ST) drugs that do not go through the normal Step Process.

• Brand drug when the generic is available.

Approval may be given for a documented medical need. Otherwise, the request will be denied.

General Benefit Exclusions (Not Covered) • Drugs for cosmetic purposes

• Infertility drugs

• Experimental drugs

• Foreign drugs

The ‘Medication Request Process’ is not available for excluded drugs but denied requests can be appealed.

Improving Opioid SafetyOn January 1, 2019, L.A. Care started new pharmacy opioid safety procedures to help keep our members opioid safe. These include:

• Limits on high-dose opioids

• Limits on opioids and benzodiazepines (benzos) used together

• Limits on use of multiple long-lasting opioids used together

• Limits on how soon controlled medications can be refilled

Talk to your doctor about steps to increase your safety when using opioids and other controlled medications.

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Nondiscrimination and Accessibility StatementL.A. Care complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. L.A. Care Health Plan cumple con las leyes federales de derechos civiles y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Language Assistance Services in Your Language

Important Phone NumbersL.A. Care Covered™ Direct 1.855.270.2327 (TTY 711)

L.A. Care Family Resource Centers1.877.287.6290 (TTY 711)

L.A. Care Compliance Helpline (to report fraud or abuse) 1.800.400.4889

L.A. Care Health Education1.855.856.6943

L.A. Care Language/Interpreter Services1.855.270.2327 (TTY 711)

L.A. Care Nurse Advice Line(for non-emergency medical advice) 1.800.249.3619 (TTY 711)

Beacon Health Options(behavioral health care) 1.877.344.2858 (TTY 1.800.735.2929)

Would you like to receive Stay Well via email?Sign up now at lacare.org/stay-well. It’s that simple!

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In this issue

PRSRT STD U.S. POSTAGE

PAID Anaheim, CA

Permit No. 288

LA1105 04/19

S P R I N G 2 019

Live a Longer, Healthier Life . . . . . . . . . . . . 1Keep Your Child Happy . . . . . . . . . . . . . . . . 2My Health In Motion™ . . . . . . . . . . . . . . . . . 2Get a Checkup. It’s Free! . . . . . . . . . . . . . . . . 3Spring Is Here!. . . . . . . . . . . . . . . . . . . . . . . . . 3Sweeten Your Life . . . . . . . . . . . . . . . . . . . . . 4Do You Need to See a Doctor? . . . . . . . . . . . . 4

Protect Yourself . . . . . . . . . . . . . . . . . . . . . . . 5Take Care of Your Mental Health . . . . . . . . . . 5The L.A. Care Formulary Has You Covered . . . . . . . . . . . . . . . . . . . . . . . . 6Improving Opioid Safety . . . . . . . . . . . . . . . . . 6Important Phone Numbers. . . . . . . . . . . . . . . 7

Thank you for being an L.A. Care Covered™ Direct Member.

A Newsletter for L.A. Care Covered™ Direct Members